WHO/INRUD core prescribing indicators and antibiotic utilization patterns among primary health care facilities in Ilala district, Tanzania

Abstract

Background Antibiotic use requires regular monitoring to prevent emergence of antibiotic resistance. Objectives To assess antibiotic prescribing patterns at health care facilities (HCF) in Ilala district, Tanzania. Methods A 1 year retrospective study was conducted in four HCFs using WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators. Factors associated with antibiotic prescription were analysed using logistic regression model. Results A total of 604 prescriptions were reviewed. Patients had median age (IQR) of 15 (4–31) years with majority having upper respiratory tract infection 33.3% (n = 201), urinary tract infection 31.1% (n = 188) or diarrhoea 21.2% (n = 128). Out of 624 prescribed antibiotics, amoxicillin was the most common (22.7%), followed by ciprofloxacin (13.6%) and metronidazole (11.6%). The studied HCFs had an average of 1.99 medicines prescribed per consultation (reference: 1.6–1.8). Of 1203 medicines prescribed, 51.9% (n = 624) were antibiotics (reference: 20.0%–26.8%). Additionally, 97.6% (n = 609) of the antibiotics appeared on the national essential medicines list, whereby 84.4% (n = 510) were prescribed by generic names (reference: 100%). Patients with peptic ulcers had a 4.4-fold higher chance of receiving antibiotics [adjusted odds ratio (aOR) = 4.4, 95% CI = 1.918–10.13, P = 0.0001] while patients with diarrhoea had a 2.6-fold higher chance of receiving at least one antibiotic (aOR = 2.6, 95% CI = 1.206–5.491, P = 0.015). Conclusions We found inappropriate use of antibiotics in the studied primary HCFs. Antibiotic stewardship programmes should be extended to primary HCFs found in Ilala district.

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

“…Although most URTIs have a viral aetiology and have a selflimiting course, antibiotics are commonly prescribed. 32 This observation is in line with other previous pieces of published literature that have demonstrated this association. [33][34][35][36] The patient and the public should be informed that most of the acute URTIs are viral in origin and they require supportive therapy and not antibiotics.…”

“…However, when clinicians are unwilling to go through the procedures or when procedures are not available, prescription of an antibiotic will be the easy way out and without taking risk for possibility of untreated or delayed treatment of a bacterial infection. Although most URTIs have a viral aetiology and have a self-limiting course, antibiotics are commonly prescribed 32. This observation is in line with other previous pieces of published literature that have demonstrated this association 33–36.…”

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

“…Since URTIs were the most frequent diagnosis (22.8%), this may explain why the penicillins were the most prescribed antimicrobials (Table 2). Other studies have also shown that the penicillins (β-lactams) are among the most prescribed and dispensed class of antibiotics in ambulatory care given the high prevalence rates of URTIs [2,65,[74][75][76][77]. β-lactams have continued to be the mainstay of antimicrobial therapy due to their wide spectrum of activity against both gram positive and negative organisms.…”

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